Don’t Jinx It #dblogcheck

NEVER say, “lows have not been an issue,” or by gosh you will immediately have them EVERY. SINGLE. DAY. I’ve been fighting late day-into-the-night crashes every day since Saturday. I know exactly why – ye olde monthly female visitor has whacked out my hormones, and gone overboard with reducing my insulin resistance. Yay, for reducing insulin resistance! Boo, for causing me to have to drink milk and juice boxes at the most inopportune of times. The female reproductive system just adds even more of a juggling act into the work I’m already doing to manage blood sugars and food intake with this new stomach of mine.

Last week, I was just swimming along, started into being able to eat a “soft, mechanically altered” diet (yum!!), and have been so happy to get to eat the most extensive variety of foods that I’ve had in the past 5+ weeks since before prepping for sleeve surgery. (It’s still not a full regular diet, but I’m getting there!) However, the added tastes and nutrition have not come without their challenges.

Last night's dinner

Last night’s dinner – a couple tablespoons of hummus, and some Trader Joe’s Wine Country Chicken Salad with Cranberries and Pecans. (I tried to avoid the pecans, since technically, they are not “soft food.”) DELICIOUS! And I still didn’t finish all of this…..

Because I’m not relying as heavily on protein shakes and mixes in order to get in protein now, I have to work REALLY hard to make sure each meal has a high % of lean protein as my primary source of nutrition. Then, I also need to add in some soft vegetables, and a teensy-weensy bit of fruit here and there.  I track everything in MyFitnessPal, so I can see how many grams of protein I get in a day (needs to be between 60-120g), how many carbs, calories, etc. I also look at vitamins and minerals, and 2 places where I continue to struggle to get in enough is Iron and Vitamin C. With the Iron, I’m sure it’s because I’m still not consuming as much pure meat as I used to. And with the Vitamin C, I limit my fruits SO much because of the sugar spikes I will inevitably get, so I know I’m lacking there. I have been drinking a lot of Vitamin Water Zeros to try to add in more Vitamin C, AND it helps keep me hydrated as well because I’m supposed to be drinking 64 ounces+ of fluids everyday. It’s a LOT to juggle, just making sure I’m getting nutrition, fluids, taking all my vitamins and supplements each day, keeping my blood sugars in check, and oh yeah – shouldn’t I be exercising?

Argh. My energy level is still so low, but in my follow-up visit with my surgeon last week, he said it was necessary for me to start doing some strength training now, so I don’t waste muscle instead of burning fat. And more muscle will help me burn more fat. I want that, for sure! Went last night with a friend, and signed up for a local “anytime” gym, so that I can find the best time of day to go that works for me. Probably mornings, if I can drag myself out of bed. More on the exercise topic (and challenges) in a later post.

So far, I’ve lost a little over 25 pounds since starting the liquid diet before surgery. I don’t want to jinx it! Every day, I see the scale move just a little more, and it is very motivating. But in order to keep up the momentum, I HAVE to exercise, whether I have the energy or not. Most days, I’m only getting in 600-700 calories, but I will need to up that when I exercise, I’m sure.

I will carry juice boxes everywhere.

(Today is #dblogcheck day!  http://tobesugarfree.com/2014/07/21/dblogcheck-is-tomorrow/)

 

 

Gastric Sleeve Surgery and Blood Sugars

I’ve had a handful of surgeries in the past 20 years since being diagnosed with Type 1 diabetes, and there are a few tips and tricks I’ve learned that have helped immensely:

  1. I want to be the FIRST surgery of the morning. Since you’re supposed to stop eating/drinking anything at midnight the night before, it’s much easier to manage blood sugars for a short amount of time in the morning before a surgery rather than attempt to manage sugars all day on an empty stomach, risk potential lows you might have to treat with food/drink, thus negating the whole not-eating-after-midnight thing.
  2. Better to risk running high than running low. The night before surgery, I usually cut back my basal rate to about half of what it normally is. I don’t do any corrections for high blood sugar unless it starts running over 200. Then, I very conservatively correct – again, give myself about half of what I normally would to correct it.
  3. FILL OUT PAPERWORK ahead of time that says YOU take responsibility as soon as possible after surgery for your own diabetes/insulin/blood sugar management. No nurse or doctor knows how to work my insulin pump and CGM better than I do, and I had no desire to go back to getting injections at the whim and on the time-frame of nurses who don’t understand MY diabetes.
  4. Take at least 1 brightly colored piece of paper with you that states you are type 1 and notes your management regimen. For example, mine said, “TYPE 1 DIABETIC, on Insulin Pump and Continuous Glucose Monitor (CGM.) Please NO acetaminophen – it disrupts my CGM.”  This worked very well for me during this stay – had several nurses comment that it was very helpful for them to see that in my chart and know it immediately when they were treating me. (It also led to several educational moments where nurses had never seen a CGM before, so of course, I showed them and explained the whole she-bang.)
  5. Ask if it’s OK for that surgery to keep on your insulin pump port-site, and/or your CGM sensor. For my c-section, my OB preferred I didn’t have anything foreign on my skin or body, but for this surgery (since it was obviously way higher up on my torso), every nurse, doctor, and anesthesiologist I talked to said I could keep them on.

Now, onto gastric sleeve surgery …..that morning of surgery, I kept my pump hooked up  – running on 1/2 my usual basal rate – and also kept my CGM sensor on and the receiver with me until the very last minute when they were going to wheel me back to the operating room. Then, I relinquished my pump and CGM receiver to my husband for safe-keeping.

IV, Pump, and CGM, oh my!

I was running in the 180s right before surgery, which was perfectly fine with everyone involved.
Immediately post-surgery in recovery, I have no idea what my blood sugars were there – I was just trying to get reoriented and awake from anesthesia, and make sure they gave me some more pain meds. Thankfully, they got enough pain meds into me fast enough so I wasn’t very uncomfortable for long. Waking up from a surgery – always surreal for me.

Once I was in my own room and my husband gave me back my CGM and pump, I fingerstick tested (just to calibrate the CGM for good measure), and I was somewhere around 270. I knew I wouldn’t be eating or drinking anything for the rest of the day, so I wanted to be very careful about correction bolusing. I gave myself about 1/2 of what I thought I needed to bring it down to 150. Waited a couple hours. I had a decently steady downward-heading arrow on the Dexcom, so I just kept doing little correction boluses until I got down to 150, then I stopped.

Amazingly, for the next 24 hours, I had steady and decent blood sugars. Of course, I consumed literally NOTHING on the day of surgery – not even a sip of water (thank goodness I was on IV fluids, but my mouth felt like a desert.) And the following day, I could start on clear liquids, but that meant broth, water, sugar-free lemonade, and the like that had zero carbs and minimal calories. You can see my Dexcom graphs below, but it doesn’t show what I was doing with my insulin and boluses. Short answer = I kept my basal rate at close to 1/2 of what it used to be (for me, that is 1 unit per hour), and made only teeny tiny correction boluses here and there (of like, 0.5 unit)  if my sugar started sneaking upwards.

Day of surgery graph

Day of surgery blood glucose graph, from 12 midnight to 12 midnight. NO food or drink.

Day after surgery graph

Day after surgery blood glucose graph – on clear liquids only.

Now, the 3rd day after surgery, I was allowed to start on “full” liquids again, which meant the nasty protein shakes, 1% milk, sugar-free Jello, chicken broth, sugar-free Popsicles, and all that sort of stuff.
That is when blood sugar management got….interesting. The second I had a protein shake that morning with milk in it, my blood sugar RACED up to the  mid-200s. Seriously, it was like dawn phenomenon, the breakfast spike, and who knows what else all came into play at once.  You know how many carbs were in that shake? Like, a measly 13g. And the spike happened after I’d taken only maybe 2 or 3 sips, so I’d be surprised if I had consumed 1g of carbs at that point.

Spikey spikey

On full liquids, “breakfast” spike and subsequent calm-down over the course of each day. My graphs looked like this for several days, until I let the Metformin kick in again AND started bolusing at least a little something well-before I started sipping on my breakfast.

  • Note: I had not returned to taking my Metformin, but decided to start back after a couple of days of these spikes. Realization? My insulin-resistance wouldn’t just suddenly disappear after surgery, it would take time to lose some weight and hopefully get it down that way.
  • Another note: On all liquids, whatever I intake now hits my system *almost immediately*, and I had gotten into the habit of bolusing right when I eat, using dual-wave boluses, etc. Nope, NOW I need to bolus well *ahead* of eating/drinking, so that the insulin has some time to get into my system before I consume something that takes zero time to digest.
  • Crap, one more note: I waited a couple days post-surgery before I reset my basals back to the rates they were before surgery. With the weird spikey spikey happening, I guessed (correctly) that I needed a higher basal rate back again, regardless.

I hope this is all making some sort of sense. Today, I’ve actually had a pretty decent blood sugar day, and my spike this morning was not nearly as bad! I am hoping I’ve turned a corner in understanding how fast my stomach is digesting things now, and can take insulin accordingly/ahead of time to help stave off that spike. BUT, I know things will be changing in the weeks to come as I introduce “regular” food back into my diet. For reference, here is the upcoming schedule of how I am working up to eating regular food again while my stomach heals from surgery:

Bariatric diet stages post-surgery

It’s going to be a wild ride on the roller coaster of blood sugars, I’m sure! 🙂

Even more notes: I am NOT a doctor or medical professional of any kind, and am just sharing my personal experience. Individual bodies are different, and just because this is how MY body is working as a Type 1 post-surgery for gastric sleeve, it doesn’t mean that everyone else’s will work this exact same way! Your Diabetes May Vary. 

 

Week in Pictures Roundup

I know it’s Wednesday, and might be kind of odd to do a “week in review” post (honestly, it’s more like a week-and-a-couple-days in review”), but that’s what you’re getting today. Kind of goes along with the “Wordless Wednesday” theme, although you know, I’m rarely “wordless.”

And this was the highest it was for most of the morning.

My blood sugar at the end of the Dance Dash 5k. After snarfing tons of carbs along the way, just to keep from falling out from running so low. Thank goodness my husband came along to feed me and watch our daughter.

She keeps me going, even when I feel like stopping

Recovering from the lows, and feeling good to be with my family. I need to work more on my strategies for managing blood sugars while exercising, obviously.

Loss is inevitable.

A somber trip to the mountains to say goodbye to my uncle who died of bone marrow cancer.
RIP Uncle Roger.

Just hanging around

Fun at the park for a 2 year old friend’s birthday party

Electric running (OK, walking) was the best!

My team who did the Electric Run 5k. OK, so most of us walked it. My sugar crashed of course (again) but I made it through. A night filled with friends, lights, and LED displays made the exercise worth it!

Mmmm, cupcakes

Morning after the Electric Run 5k, I walked the Cupcake Fun Run 5k. With cupcakes available, surely my blood sugars would survive?!! They did OK. But only because I ate 1 cupcake before, and 1 cupcake after. (No judging – I NEEDED those cupcakes!)

Whew, almost done!

Stopping for a photo op – thankfully, not a major crash during this 5k, but still a little tenuous for blood sugar management. Even with the cupcakes.

Mmmmm, cake!

We won Parents of the Year this day. Cupcakes in the morning for the 5k, and birthday cake that afternoon at a friend’s 1 year old’s party. Our daughter was on a sugar high, to be sure. Check out all the kids/vultures “helping” this little guy with his smash cake. Too cute.

Don't let the Quetzocoatalus get you!

After two 5ks over the weekend, it made sense that we should spend Sunday walking even more at the Zoo, right? Penny wanted to go see the Dinosaurs. She was terrified of the animatronic creatures last time, but assured us she would be fine this time. Never trust a 2.5 year old.

Whew. I think I’ll go take a nap for the next 5 days now.

Don’t Mess with this Fairy

My husband is due home tonight after being away for 5 REALLY long days. (He went to GenCon. I couldn’t get away from work due to some big projects, and we weren’t quite sure we were ready to leave our daughter for that long with anyone else, so I took the hit for the team and stayed behind.  I am still very jealous, but happy he got to have some super fun and scope it all out to prepare us for our trip together next year – for sure, I’m going!!)

I’ve had plenty of challenges this week, and it’s times like these that make me totally respect and admire single moms and dads. Being solely responsible for a kid 24/7 is exhausting business. Add on the ups and downs of blood sugars, and it can sometimes be the perfect storm of fun-suck.
I have had a couple of crashes, and some stubborn lows the past few days – chasing around a very active 2 year old tends to mirror the effects of 90 minutes of aerobic exercise for me – but overall, I think we both came through it with flying colors. I mean, we’re both still alive, right?

And speaking of colors, we had an amazingly fun time yesterday at a friend’s birthday party – theme: Princess Dress-up. Our household isn’t really into princesses, especially not the damsel-in-distress kind, but we’re keeping an open mind, and will let our daughter find her own way in what she likes. So far, it’s been like pulling teeth whenever we *wanted* her to put on dressy outfits for pictures or for playtime, so I wasn’t sure how the party would go. After some stressful dress-picking (and her asking to put on a robot costume instead – the one she has at home of Optimus Prime) she got all dolled up and really had a fabulous time with all the other Princesses and Fairies. Here’s just a few pics that were so cute I had to share. Happy Sunday!

She won't sit still 2 seconds for me to clip her fingernails, yet she begs for a stranger to paint them?

She won’t sit still 2 seconds for me to clip her fingernails, yet she begs for a stranger to paint them?

Bad-ass Fairy with a Scimitar tattoo. Seriously, don't mess with her.

Bad-ass Fairy with a Scimitar tattoo.
Seriously, don’t mess with her.

Instead of walking the red carpet by herself in the final show, she wanted to run with the Wizard and Knight. Girl knows it's best to have a well-balanced adventuring party.

Instead of walking the red carpet by herself in the final show, she wanted to run with the Wizard and Knight. Girl knows it’s best to have a well-balanced adventuring party.

The Beach ate my Insulin

Just got home last night from spending a wonderful long weekend at the beach with my daughter, husband, and family friends who also have kids. Anyone who knows me knows that I am more of a mountain girl – I much prefer hiking and exploring the scenic views in the mountains and having a picnic by a babbling brook over baking myself in the heat of summer and cleaning sand out of every orifice of my body. I mean, the beach has it’s scenic views, and the crashing of the waves can be very relaxing….it’s just, I don’t ever feel like it’s worth all the mess and cleanup, and then there is also the planning and packing and preparing just to be able to moderately enjoy a day on the beach. (See the Swimming with Diabetes post for some similar highlights of what has to be done just for a “quick” trip to the beach or any body of water.)

I love all the firsts with my little girl

Touching the ocean for the first time

But I have to say, it was truly a joy to see my daughter experience the ocean and the beach for the first time, and I’m so glad I sucked it up and made the effort to go. She LOVES playing in the sandbox, and loves the pool, so we knew the beach would be a hit. And it was. So much so that, on the way home yesterday when she woke up from her nap, we told her we were almost home. She happily exclaimed, “Beach house!” and we were like, “no, back to our house at home” and she immediately burst into tears.  Trust me, sweetie, I wish we could vacation all the time, too!

And hope it never becomes needed.

Good Mommy, wearing my medic-alert bracelet!
Just in case.

Anyway, back to how the beach ate my insulin…we got there on Friday, and made the short walk to the actual beach front  (just a few hundred feet from the house we stayed in) to check it out. I had planned ahead and changed out my pump infusion set that morning so I had a fresh 300 units to get me through the majority of the weekend. Friday was a great blood sugar day and night – the walk to the beach, plus a sensible dinner and a glass or two of red wine were easy pickings to account for – my sugars were generally steady, and between 80-130. The only negative diabetes thing was that the shorts I wore to explore the beach got a little wet and were rubbing on my Dexcom sensor *just so* that it ripped it off. Replaced the sensor – a little bitter because I probably had another good week and a half left on it.

Saturday morning, we carted a truckload of supplies – sand toys, life jackets, boogie boards, towels, chairs, a tent, and a cooler filled with snacks –  and spent several hours enjoying the sand and the ocean. I played it safe, and spent the majority of the time in the shade of the tent. It really wasn’t even very hot, in the grand scheme of the beach. Maybe in the 80s? So, I wore my pump and CGM while I was watching everyone, and if I went into the water to play, I would put my pump in a Ziploc bag and leave it inside the cooler (not directly on any ice) and make sure the CGM receiver was in a safe non-watery place. (My CGM sensor itself was now applied with Skin-Tac and copious amounts of Opsite Flexifix tape, so I was pretty sure the ocean wouldn’t whisk it off my leg.) It probably took me til Sunday morning to realize something was amiss with my sugars, and to blame it on the pump/potential skunky insulin. So, I implemented a cautious change out, wasting many units of insulin. Grrrr.

See the green tent - my shaded haven

See the green tent – my shaded haven

Sunday was an OK day blood sugar-wise….we visited the NC Aquarium at Pine Knoll Shores, so we were inside during the main heat of the day. But we also went on a short nature hike outside while there, and that got a smidge hot. We also went to the beach again that afternoon. Ironically, my sugars started climbing again that afternoon, and were hanging out in the 180s and 190s no matter what I did (drank tons of water, took more insulin through the pump, used a different bottle to give a shot of insulin, ate something, etc.)

Wheeee, the beach! Yes, I'm wearing a t-shirt. Not fashionable, but I also didn't get sunburned, so there.

Wheeee, the beach! Yes, I’m wearing a t-shirt over my suit. Not fashionable, but I also didn’t get sunburned, so there.

By the time we headed home Monday, I was really tired of high sugars making me feel like crap. We stopped and played a round of miniature golf on the way home (and I putt-putted the best score of my life – 34!!) and that got to be hot – possibly as hot as our days on the beach. More insulin skunkiness caused? I had tons of insulin still left in the cartridge, but got home and immediately changed it all out with a new bottle of insulin and a new infusion site yet again. Finally, my sugars leveled out and started making sense again. I was just so frustrated that I wasted at least a couple hundred units of insulin over the weekend because my insulin got too hot while it was sitting on my body (yes, I wear it in my bra 99% of the time.) I also threw out the bottle that was in my pocketbook, since I had used it to supplement with shots when my sugar was so high, and even the shots didn’t seem to make a dent. Wondering if that insulin was exposed to too much heat at some point in our travels?

Grrrr, I hate wasting insulin. Either this bottle has had it, the insulin in my set has had it, or both.

Grrrr, I hate wasting insulin. Either this bottle has had it, the insulin in my set has had it, or both.

Sweetly Voiced recently wrote about the checklist of items we go through when trying to figure out why our blood sugars may be high (and I wondered about all these things several times over this past weekend) and brought up a good point – why isn’t there a test strip or way we could check our insulin in order to figure out it’s gone bad? I hate tossing an entire bottle, or 200 units left in my infusion set, if it could possibly be something else. In this weekend’s instance, I’m just going to say the beach ate my insulin. You think my insurance company would replace a bottle of insulin for me for free if I tell them that? Ha.

Lancets – the good, the bad, the gross

From hanging out in the DOC for a few years now, I think I can safely say that a LOT of us have a very lackadaisical attitude towards lancets. Sure, we use them on a daily basis, and have to have them to support our blood sugar testing, but as for brand names, which ones perform better than others, etc, I don’t see a lot of discussion around it, and no one seems to care a lot about lancets. (Except for the FDA, apparently. What a load of who-ha.)  There isn’t any dedicated research (that I know of) or earth-shattering discoveries being made around “how to make a better lancet.”  I am not talking about non-invasive glucose monitors here, I’m just talking about lancets. Lancets are pretty simple tools we use to break through our skin, draw blood, and use that blood to test our blood sugar.  (True, lancet-devices themselves may differ, but that little piece of skin-poking metal is pretty universal.)

As for our various uses and hygienic standards surrounding how we use lancets….now, there’s another story.  I remember in the early days of having diabetes, I was religious about washing my hands and/or alcohol swabbing my finger before ever jabbing it with a lancet/lancet-device. After each use of a lancet, I would take it out of the lancet-device, cap it with the twist-top from a new lancet, put the new lancet into my device so it was ready for next time, then discard the old one into my sharps container. (I’m sorry, I’m laughing at my-naive-fresh-faced-21-year-old-diabetic-self as I write this. Let me compose myself.)

Fast forward 19 years. I can’t remember the last time I refilled an Rx for lancets or bought a new package of them. The ones I have in my diabetes supplies zones have long-overdue expiration dates on them (I think), but really – what’s there to “expire?” Maybe their sterility could be compromised after so many years? I even have a box of rainbow-colored lancets. Those make me more cheerfully stab my fingers. (Not really, but let’s just pretend.)

Deutsch: Einweglanzette (Nahaufnahme)

A Lancet (Photo credit: Wikipedia)

But if we’re talking about things being sterile – that went out the window years ago. I do still wash my hands – most of the time – but definitely if I’ve eaten recently because I don’t want any rogue food particles to mess up the sugar reading. I am sure I use the same lancet hundreds (yikes, maybe thousands??) of times before I remember to change it out. I have a CGM, but I still finger-stick test at least 5-6 times per day, and more if I’m on the first or last few days of a CGM sensor. In one month, I’d say I could use the same lancet at least 150 times, so it hits 1,000 times in 6 months, easy.

I’m trying to get better at switching out the lancet more often than once in a blue moon. With my recent stupid finger infection, I can see where I may be more prone to infection here in my older age, and even though I am a chronic hand-washer, germs still abound. I have a 2 year old. We are involved in potty training. Dirt and germs are EVERYWHERE. I promise – and I’m announcing this to the world so now I’ll be held accountable – I will try to do better at changing out my lancet, for the sake of not getting any more infections that could have been prevented.

The event that actually spurred (ha ha) me into writing this post was how I find myself using lancets for several things OTHER than their intended use. In these cases, I do always use a sterile one fresh from the box. And if I ever test someone else’s blood sugar, I always use a clean one for them, and replace it after it’s used with a new one for me. I don’t joke about that stuff.

I have used lancets for a multitude of problems….they are perfect for clicking the microscopically tiny reset buttons on various electronics, popping zits, helping dislodge splinters, digging out sock lint from my toenails, and picking out food trapped between my teeth. (Too much information? It gets better.) The other week, I had this weird pimple-like boil on my belly, right at my waistband line. I thought it looked like a zit and I’d popped it a week or so before, but it came back and was looking kind of angry now, so I performed minor surgery on it – using alcohol swabs and 2 lancets. A fair amount of blood was expelled, along with some pimple-juice-like-substance. It went from being swollen and red to flat and healing – that sucker cleared up in no time! (I think I’ve been watching too much Walking Dead. That didn’t gross me out one bit.)

Anyway….what are your thoughts on lancets? Any fun info or amusing uses that you have found for them?